Unusual Iatrogenic Lesion of the Musculocutaneous Nerve – Two Case Reports

Czech version

Authors: M. Kanta ¹; E. Ehler ²; D. Laštovička ¹; J. Habalová ¹; M. Bartoš ¹; S. Řehák ¹
Authors‘ workplace: Neurochirurgická klinika LF UK a FN Hradec Králové ¹; Neurologická klinika FZS UP a Pardubické krajské nemocnice, a. s. ²
Published in: Cesk Slov Neurol N 2010; 73/106(4): 434-437
Category: Case Report

Overview

Traumatic lesions of the musculocutaneus nerve are uncommon and most cases involve additional neuromuscular injury, making diagnosis difficult. With appropriate surgical repair, the potential for regeneration is relatively good. We present two unusual cases of iatrogenic musculocutaneous nerve injury involving damage to the lateral cord of the brachial plexus. In the first case, the nerve injury resulted from osteosynthesis of the proximal humerus following a traumatic fracture with concomitant radial nerve injury. Five months later, during surgery, the clearly-severed musculocutaneous nerve was identified at its branching away from the lateral cord of the brachial plexus. Micro-anastomosis using sural nerve grafting of both the radial (7 cm) and the musculocutaneous nerve (5 cm) was performed. In the second case, the lateral cord of the brachial plexus, including the musculocutaneous nerve, was damaged in the course of orthopaedic surgery to the shoulder (Bancart’s procedure). The patient was re-operated five months later and end-to-end micro-anastomis was performed. Musculocutaneous nerve re-innervation was successful, but 12 months later the patient was again re-operated in response to pain in the upper arm caused by nerve compression arising out of scar tissue formation. The aim of this paper is to draw attention to iatrogenic nerve injury as a result of various surgical procedures to the upper arm and to the positive results of surgical treatment.

Key words:
fracture of humerus – radial nerve – musculocutaneus nerve – lateral cord – iatrogenic lesion

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